---
type: source
title: "Comprehensive Access to Semaglutide: Clinical and Economic Implications for Medicare"
author: "Value in Health (peer-reviewed journal)"
url: https://www.valueinhealthjournal.com/article/S1098-3015(25)02472-6/fulltext
date: 2025-06-01
domain: health
secondary_domains: [internet-finance]
format: paper
status: processed
priority: high
tags: [glp-1, semaglutide, medicare, cost-effectiveness, cardiovascular, CKD, MASH]
processed_by: vida
processed_date: 2026-03-18
enrichments_applied: ["GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md", "glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md", "semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings.md", "the healthcare cost curve bends up through 2035 because new curative and screening capabilities create more treatable conditions faster than prices decline.md"]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

Peer-reviewed modeling study estimating the comprehensive value of semaglutide in the Medicare population for current and future FDA-approved indications (type 2 diabetes, overweight/obesity, MASH). Modeled clinical outcomes and costs over a 10-year period (2026-2035).

Key findings:
- Net financial impact to Medicare: savings of $715 million over 10 years (range: $412M to $1.04B depending on utilization/price assumptions)
- 38,950 cardiovascular events avoided over 10 years
- 6,180 deaths avoided (CV events + CKD/MASH progression improvement)
- T2D-related impact: savings of ~$892 million
- Obesity-related impact: added costs of ~$205 million
- MASH-related impact: savings of ~$28 million
- Per 100,000 subjects treated: 2,791 non-fatal MIs avoided, 3,000 coronary revascularizations avoided, 487 non-fatal strokes avoided, 115 CV deaths avoided
- Average per-subject lifetime treatment costs: $47,353
- Savings from avoided T2D: $14,431/subject; avoided CKD: $2,074/subject; avoided CV events: $1,512/subject

## Agent Notes
**Why this matters:** This directly challenges our existing claim that GLP-1s are "inflationary through 2035." Under Medicare specifically, the modeling shows NET SAVINGS when multi-indication benefits are accounted for. The distinction between system-level inflationary impact and payer-specific savings under risk-bearing arrangements is the core of the VBC interaction question.
**What surprised me:** The T2D-related savings ($892M) actually exceed the obesity-related costs ($205M). The MASH savings are tiny ($28M) despite the impressive clinical data — suggests MASH treatment costs don't accumulate enough in the 10-year window to produce large offsets.
**What I expected but didn't find:** No breakdown by MA vs. traditional Medicare. No analysis of how capitated vs. FFS payment models affect the cost-benefit calculation differently.
**KB connections:** Directly relevant to [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]] — this study complicates the "inflationary" conclusion. Also connects to [[the healthcare cost curve bends up through 2035 because new curative and screening capabilities create more treatable conditions faster than prices decline]].
**Extraction hints:** Potential claim: "Comprehensive semaglutide access saves Medicare $715M over 10 years because multi-indication cardiovascular and metabolic benefits offset drug costs when a single payer bears both costs and savings." This would need to be scoped carefully against the system-level inflationary claim.
**Context:** Published in Value in Health, a peer-reviewed health economics journal. Study appears to use Novo Nordisk-favorable assumptions (net prices with rebates). The $715M figure is modest relative to total Medicare spending but significant as evidence that prevention CAN be cost-saving under the right payment structure.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]]
WHY ARCHIVED: This study provides the strongest evidence that the "inflationary through 2035" framing needs scope qualification — system-level vs. payer-level economics diverge when downstream savings accrue to the same entity
EXTRACTION HINT: Focus on the distinction between system-level cost impact (inflationary) and risk-bearing payer impact (potentially cost-saving). This is the core VBC interaction.


## Key Facts
- Medicare semaglutide modeling shows net savings of $715M over 10 years (range: $412M to $1.04B)
- T2D-related impact: savings of ~$892 million over 10 years
- Obesity-related impact: added costs of ~$205 million over 10 years
- MASH-related impact: savings of ~$28 million over 10 years
- 38,950 cardiovascular events avoided over 10 years with comprehensive semaglutide access
- 6,180 deaths avoided (CV events + CKD/MASH progression)
- Per 100,000 subjects treated: 2,791 non-fatal MIs avoided, 3,000 coronary revascularizations avoided, 487 non-fatal strokes avoided, 115 CV deaths avoided
- Average per-subject lifetime treatment costs: $47,353
- Savings from avoided T2D: $14,431/subject; avoided CKD: $2,074/subject; avoided CV events: $1,512/subject
